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A  N 


INAUGURAL   DISSERTATION 

O  N 

CHRONIC  MANIA. 


SUBMITTED  TO  THE  PUBLIC  EXAMINATION 

OF     THE 

FACULTY    OF    PHYSIC, 

UNDER   THE  AUTHORITY  OF   THE 

TRUSTEES  OF  COLUMBIA  COLLEGE 

IN    THE 

STATE  OF  NEW-YORK: 
WILLIAM  SAMUEL  JOHNSON,  LL.D.  Prefident; 

FOR  THE  DEGREE  OF 

DOCTOR  OF  PHTSIC. 

ON    THE    THIRD    DAY    OF    MAY,     1796, 


By  ALEXANDER  ANDERSON, 

Citizen  of  the  State  of  New- York. 


Chiefly  where  Solitude,  fad  nurfe  of  care, 
To  fickly  muling  gives  the  penfive  mind, 
There  Madnefs  enters;   and  the  dim-ey'd  fiend, 
Sour  Melanchuly,  night  and  day  provokes 
Her  own  eternal  wound. 


Armstrong. 


NEJT-YORK: 

r>s,  Printers 
liege,  No.  99 

—  i796.— 


Printed  by  T.  and   J.  Swords,  Printers   to  the  Faculty  of  Phyfic  of 
Columbia  College,  No.  99  Pearl-ilreet. 


/If  ,L^-  (  '/ft  /  / 


'  f 
/   X? 


/7fl 


DEDICATED  TO 


Doctor   JOSEPH    YOUNG, 


AS  A  MARK  OF 


RESPECT  AND  GRATITUDE 


FOR  HIS  ATTENTION  TO  THE 


MEDICAL  INSTRUCTION 


The  Author, 


Digitized  by  the  Internet  Archive 

in  2011  with  funding  from 

Open  Knowledge  Commons 


http://www.archive.org/details/inauguraldisserOOande 


A  M 

INAUGURAL  DISSERTATION 

O  N 

CHRONIC  MANIA. 


INTRODUCTION. 

.ANKIND,  from  innumerable  caufes,  may  be 
deprived  of  the  ufe  of  reafon.  The  difficulties  at- 
tending the  inveftigation  of  a  fubject  fo  intimately 
connected  with  the  phenomena  of  the  mind,  may 
account  for  the  many  unfatisfaclory  conjectures  hi- 
therto offered,  as  well  as  for  the  imperfections  of  the 
following  attempt. 

It  is  difficult  to  define  that  ftate  of  the  intellectual 
faculties  which  may  be  faid  to  conftitute  a  reafonable 
being  •,  for,  fo  various  are  the  fenfations  of  different 
people,  and  their  conclufions  from  them— fo  imper- 
ceptible the  gradations  from  a  flight  error  in  reafon- 
ing  to  fatuity,  that  we  can  fcarcely  fay  where  ration- 
ality ends  and  folly  begins. — No  lefs  difficult  would 

the 


i  e  ) 

die  tafk  be  to  determine  the  point  at  which  madnefs 
commences,  fince  every  inordinate  indulgence  of  the 
paffions  partakes  of  it  j  and  even  low  fpirits  and  ab- 
fence  of  mind  may  be  reckoned  as  {lighter  degrees 
of  the  fame  affection. 

Some  have  made  the  characteriftic  of  madnefs  to 
confift  in  a  mode  of  thinking  and  acting  different 
from  the  generality  of  mankind :  But  this,  if  ad- 
mitted, would  evidently  include  every  great  genius, 
who,  in  the  purfuit  of  truth,  dares  to  differ  from 
others.  In  fad,  we  find  that  fuch  have  generally 
b^en  reckoned  in  this  clafs  by  thofe  who  compofe  the 
moft  numerous  rank  of  life.  Even  the  Saviour  of 
the  world  incurred  the  name  of  a  demoniac,  or,  in 
other  words,  a  madman,  notwithstanding  his  unex- 
ampled purity  of  life.  The  eloquent  defence  of  St. 
Paul,  before  Agrippa,  did  not  preferve  him  from  a 
like  epithet.* 

The  tranfition  from  poetic  ardour  to  madnefs  is 
eafy;  hence  fome  of  the  moft  fublime  flights  of 
imagination  have  been  the  productions  of  a  diforr 
dered  mind.  It  is  not  improbable  that  the  refponfes 
of  the  ancient  oracles  were  delivered  by  their  priefts 

while 

*  Ads  xxvi.  24. 


I     7     ) 

while  in  a  ftate  of  artificial  madnefs :  the  phrenzy  of 
the  Cumaean  Sibyl,  as  defcribed  in  the  fixth  JEneid^ 
countenances  this  opinion.  Even  at  this  day  the 
dervifes  and  priefts  of  uncivilized  nations,  by  the 
ufe  of  narcotic,  intoxicating  fubftances,  or  by  rapid 
rotations  of  their  bodies,  induce  a  fimilar  condition 
of  the  fyftem,  and  by  this  counterfeit  of  fupernatural 
appearances,  imprefs  their  devotees  with  awe  and 
reverence.  It  is  well  known  to  what  account  Ma- 
homet turned  his  epileptic  fits.  The  fame  effects 
refult  from  the  voluntary  convulfions  and  whirlings 
of  the  Shaking  Quakers  in  this  country. 

The  affinity  otdrmkennefs  to  madnefs  is  obvious : 
diftinguifhed  only  by  the  greater  diffufibility  of  the 
caufe,  and  the  fhorter  duration  of  the  effecT:,  it  will 
frequently  degenerate  into  the  latter,  efpecially  in 
thofe  who  are  conftantly  Jiarraffed  with  the  dread 
of  impending  ruin.- 

Although  the  foregoing  reflections  may  place 
mankind  in  a  point  of  view  rather  humiliating,  yet  the 
confideration  of  them  may  confirm  the  obfervation5 
that  the  medium  between  enthufiafm  and  apathy  is 
the  moft  fuitable  to  human  nature,  as  well  as  moH 
favourable  to  the  functions  of  both  body  and  mind. 

Notwithftandins: 


(     8     ) 

Notwithstanding  the  many  proofs  to  the  contrary, 
reafon  is,  by  many,  fuppofed  to  belong  exclusively  to 
man,  and  to  diftinguifh  him  fufficiently  from  the 
brute  creation,  whom  they  have  portioned  off  with 
an  imaginary  Something  called  inftinff :  the  existence 
of  this  can  never  be  proved,  while  experience  afTures 
us  that  all  our  knowledge  is  derived  from  the  opera- 
tion of  bodies  on  the  organs  of  fenfe. — Innumerable 
facts  might  be  adduced  to  prove,  that  all  animated 
beings  are  endowed  with  the  ufe  of  the  reafoning 
faculty,  in  different  degrees,  proportioned  to  their 
various  wants.  In  thofe  which  are  called  the  lower 
orders,  its  operations  are  lefs  manifeft;  ftill,  to  the 
philofophic  eye,  they  are  fufficient  to  indicate  a  ra- 
tional principle  directing  their  efforts,  and  adapting 
them  to  the  Situations  in  which  they  may  be  placed.* 

Surely 

*  Birds  do  not  always  follow  the  fame  model  in  the  con- 
struction of  their  nefts,  but  vary  them  fo  as  belt  to  afford  con- 
cealment from  their  enemies,  and  protection  from  the  injuries 
of  the  weather. 

Animals  that  are  accufiomed  to  pafs  the  winter  in  a  torpid 
ftate,  when  removed  to  warm  climates  totally  lofe  this  habit. 

Some  bees  which  had  been  tranfported  to  one  of  the  Weft- 
India  iflands,  finding  no  neceffity  for  their  ufual  labour,  foon 
neglected  to  construct  combs  and  accumulate  honey,  and  even 
proved  troublefome  to  the  fugar-boilers. 

The  inftances  of  plants  feeking  the  light,  and  performing 
various  actions  with  fomething  like  fagacity,  are  well  known. 


(      9      ) 
Surely  this  argues  fomething  more  than  a  blind  in- 
ftinct  operating  in  a  mechanical  manner. 

In  what,  then,  it  may  be  afked,  confifts  the  dif- 
tinction  between  the  human  being  and  the  brute  ?  I 
anfwer, 

i  ft.  In  the  formation  of  the  body ;  for,  notwith- 
ftanding  the  endeavours  of  fome  naturalifts  to  ap- 
proximate them,  the  difference  between  man  and 
the  ouran-outang  is  too  ftriking  to  allow  the  idea 
of  any  relationfhip  between  them. 

2d.  Man's  pre-eminence  is  chiefly  founded  on  his 
greater  power  of  exerting  volition.  It  is  this  which 
enables  him  to  fubjecl:  other  animals  to  his  dominion, 
to  form  languages,  to  labour  for  a  circulating  me- 
dium, to  form  inftruments  and  machines ;  and  which 
prompts  him  to  adore  the  Deity,  with  the  hope  of 
procuring  future  happinefs. 

Such  is  the  condition  of  man,  that  this  very  cir- 
cumftance,  by  which  he  is  elevated  above  other 
animals,  frequently  fubjecls  him  to  a  malady,  which 
lays  the  mind  in  ruins,  and  transforms  a  rational 
being  to  a  fury  or  an  ideot. 

B  THEORY 


(     io     ) 

THEORY  OF  MANIA, 

MADNESS  may  be  defined  a  falfe  perception  of 
objects,  depending  on  morbid  fenfation,  with  a  be- 
lief m  the  truth  of  the  fuggeftions  of  the  fenfes, 
and  in  confequence  of  this,  extraordinary  and  irre- 
gular efforts  to  attain  fome  imaginary  good  or  avoid 
fome  evil.  The  violence  of  thefe  efforts  will  be  in 
proportion  to  the  hrmnefs  of  the  belief  and  the  quan- 
tity of  volition  in  the  perfon  affected. 

It  differs  from  delirium  or  typhomania  in  the  fol- 
lowing particulars:  in  thefe  the  affection  is  of  fhorter 
duration,  attended  with  an  ignorance  in  the  patient 
of  his  fituation  and  the  perfons  about  him,  together 
with  a  greater  proflration  of  ffrength. 

That  form  of  the  difeafe  which  I  propofe  to  con- 
sider, may  be  termed  Chronic  Mania.,  to  diftinguifh 
it  from  Phrenitis,  and  other  affections  of  the  mind 
depending  on  inflammatory  action.  Its  duration 
likewife  entitles  it  to  this  name-,  for,  although  ex- 
afperated  at  particular  times,  it  frequently  tinctures 
the  behaviour  of  the  maniac,  even  in  what  are  called 
his  lucid  intervals,  and  is  eafily  excited  by  flight 
caufes. 

The 


(    II    ) 

The  infenfibility  of  madmen  to  cold  has  been  of- 
fered as  a  proof  that  the  cfifeafe  is  connected  with  an 
increafed  action  of  the  veffels :  this,  indeed,  has  fome 
degree  of  plausibility,  becaufe  the  inftances  of  their 
refilling  the  power  of  fevere  froft  cannot  otherwife 
be  accounted  for,  than  on  the  fuppofition  of  a  pre- 
ternatural generation  of  heat,  which  always  implies 
increafed  action  of  the  fyftem :—  But,  I  believe,  thefe 
cafes  would  be  found  to  belong  to  phrenitis,  a  dif- 
eafe  depending  on  an  inflammatory  diathefis,  in  which 
the  abfcraction  of  heat  muft  be  eminently  ferviceable, 
and  has  fometimes  even  reftored  the  patient  to  health : 
on  the  contrary,  in  chronic  mania,  the  patient  is  co- 
vetous of  warmth,  and  careful  to  avoid  the  inclemen- 
cies of  the  weather;  or  if  expofed  to  cold,  in  their 
vagaries,  without  exercife  of  their  limbs,  the  livid 
colour  of  their  extremities  fufficiently  indicates  its 
effects  on  them.  Morgagni  relates  the  cafe  of  one 
who  peri  fried  merely  from  neglecting  to  fecure  him- 
felf  from  the  cold. 

Hence,  if  increafed  vafcular  action  is  ever  obferved 
in  this  difeafe,  it  muft  be  confidered  rather  as,the 
effect  of  the  violent  exertions,  than  the  caufe. 

From  thefe  confederations  we  are  juftified  in  affert- 

ing 


(       12       ) 

ing  the  exigence  of  a  morbid  ftate  of  the  mind,  dif- 
ferent from  phrenitis  and  delirium,  as  well  as  from 
fatuity,  and  confined  to  no  peculiar  temperament. 
Its  feat  and  caufes  I  mall  prefently  endeavour  to 
point  out. 

The  more  remarkable  characteriftics  of  this  affec- 
tion are  the  following :  a  falfe  fenfation  of  external 
objects,  a  morbid  or  unufual  afTociation  of  ideas, 
eager  purfuit  of  fome  object,  and  violent  exertions 
to  attain  it,  with  indulgence  of  exceflive  emotions, 
particularly  of  fufpicion  and  anger :  fome  are  marked 
by  a  melancholy  behaviour,  bordering  on  ftupidity, 
or  harrailed  with  groundlefs  fears  •,  while  an  uncom- 
mon gaiety  is  the  prevailing  fymptom  in  others. 

Darwin  fuppofes,  that  the  preternatural  exer- 
tions of  infane  perfons  may  be  attributed  to  an 
increafe  of  fenforial  power,  acted  upon  by  the  greater 
quantity  of  ftimulus  of  deflre  or  averfion— while  the 
force  of  thefe  mufcular  motions  may  be  augmented 
by  the  ftimulus  of  pain  or  pleafure,  as  well  as  by 
that  of  external  bodies. — Whether  the  quantity  of 
fenforial  power  is  preternaturally  accumulated,  it  may 
be  difficult  to  fay ;  but  it  is  evident,  that  an  increafed 
volition  is  exerted  in  confequence  of  a  ftrong  belief 

in 


(  n  ) 
in  the  reality  of  the  phantafms  prefented  to  the  ima- 
gination :  hence  we  are  often  led  to  impute  their 
actions  to  a  perverfion  of  will ;  and  this  has  indicated 
the  neceffity  of  retraining,  and  acquiring  a  command 
over  madmen,  in  order  to  curb  their  enormities. 

The  conjectures  of  the  ancients,  with  refpect  to 
the  proximate  caufe  of  this  diforder,  have  been  fup- 
ported  by  Boerhaave  and  Van  Swieten,  who, 
after  accuiing  an  imaginary  atrabilis  of  producing  it, 
and  labouring  to  prove  the  exiftence  of  fuch  a  caufe, 
at  laft  acknowledge,  that  all  thefe  fymptoms  may 
arife  merely  from  an  affection  of  the  mind,, 

Later  theories  afford  but  little  more  fatisfaction 
on  this  fubject.  "What  idea  can  we  form  of  an 
"  inequality  of  excitement,"  which  a  late  Profeflbr 
fo  unphilofophically  infers  from  the  inequalities  in 
the  confiftence  of  the  brain  ?  Our  ignorance  of  the 
nature  and  functions  of  the  brain  render  it  needlefs 
to  fearch  there  for  the  caufes  of  this  difeafe ;  hence 
directions  of  this  organ  throw  but  little  light  on  its 
aetiology.*     The  changes  obferved  there  may  be 

either 

*  In  fome  maniacs  the  medullary  part  has  been  found 
drier,  and  of  lefs  fpecific  gravity,  than  is  common. 

Morgagni  obferved,  io  general,  a  preternatural  degree  of 


I     H    ) 

cither  the  caufe  or  the  effect  of  the  fymptoms  enu- 
merated, or  perhaps  totally  unconnected  with  them ; 
for,  notwithstanding  the  injuries  to  which  the  brain 
is  often  expo  fed,  fuch  as  erofion  and  ulceration, 
drop  (leal  infarctions,  concuflions,  wounds,  and  even 
the  lois  of  considerable  portions  of  it,  no  affection 
of  the  mind  fimilar  to  mania  has  occurred. 

The  investigation  of  the  feat  of  ideas  may  appear 
to  be  an  ufelefs  piece  of  fpeculation ;  yet  it  becomes 
efTentially  neceffary,  in  order  to  determine  the  prox- 
imate caufe  of  a  diforder  which  more  properly  be- 
longs to  the  mind,  or  at  leaft  the  immediate  agents 
by  which  it  receives  impreffions. 

It  is  certain  that  we  poiTefs  no  ideas  but  what  are 
primarily  acquired  through  the  medium  of  the  femes, 
for  thofe  who  have  never  enjoyed  the  ufe  of  the  .or- 
gans of  fight  or  hearing,  have  no  conception  of  visi- 
ble or  audible  objects.    This  is  likewife  corroborated 

by 

liardnefs  in  the  brain,  or  at  leaft  in  fome  parts  of  it. — Bone- 
tus  found'  the  cortical  part  dry  and  friable,  and  yellow 
for  an  inch  deep. — In  fome  the  pia-mater  has  been  found 
thickened,  and  the  dura-mater  callous.  In  others  the  veffels 
of  the  brain  were  unufually  diftended,  and  the  cranium  thick 
and  without  futures. 

But  what  can  we  learn  from  all  this? 


•(     15     ) 

by  the  fact,  that  thofe  who  have  loft  both  eye-balis 
have  been  entirely  deprived  of  all  ideas  of  fight. 

By  an  exertion  of  the  memory  we  are  enabled  to 
recall  thefe  ideas  according  to  the.  laws  of  affociation  % 
and  thefe,  when  varioufly  combined  and  arranged, 
form  the  whole  of  human  knowledge.  This  faculty 
of  compounding  ideas  commences  at  a  very  early 
period,  as  may  be  obferved  in  the  conduct  of  chil- 
dren, whofe  curiofity  prompts  them  not  only  to  ac- 
quire notions  of  external  bodies,  but  likewife  to 
combine  them  in  every  variety.  The  early  appear- 
ance of  thefe  combinations  has  led  many  to  efpoufe 
the  opinion  of  their  being  innate  or  inftinctive :  how 
ill  founded  this  is  I  have  endeavoured  to  fiiow. 

Having  rendered  it  fufficiently  probable  that  the 
organs  of  {trSt  are  the  feats  of  thought,  it  next  be- 
comes neceffary,  in  the  investigation  of  this  fubjeet, 
to  examine  what  are  the  changes  on  which  the  pro- 
duction of  ideas  depends.  Thefe  changes  are  fup- 
pofed,  by  Darwin,  to  confifl  in  certain  configura- 
tions, or  motions  of  the  nervous  extremities,  which 
conftitute  the  immediate  organs  of  ftnk.  In  order 
to  prove  the  poffibility  of  thefe  motions  taking 
place,    he  has  demonstrated,  that  even  the  pulpy 

expanfion 


(     16     ) 

expannon  of  the  retina  is  compofed  of  muftular 
fibres:  its  foftnefs  is  no  argument  againft  this,  for 
we  may  fee  infects  of  a  confidence  as  foft,  which 
yet  are  capable  of  performing  a  variety  of  motions ; 
and  how  thefe  could  be  done  without  mufcles  we 
cannot  conceive. 

The  erection  of  the  papillae  of  the  tongue,  at  the 
approach  of  a  fapid  body,  implies  a  fimiiar  flruclure 
in  the  nervous  extremities  of  the  organs  of  tafte. 

The  doctrine  which  may  be  eftabliihed  from  what 
has  been  premifed,  is  this :— By  the  ftimulus  of  ex- 
ternal bodies,  certain  motions  or  changes  of  figure 
are  excited  in  the  immediate  organs  of  fenfe:  but 
thefe,  like  the  other  mufcles,  are  liable  to  an  ex- 
haustion of  their  excitability ;  and  this  indireff  debi- 
lity will  take  place  at  higher  or  lower  degrees  of  ex- 
citement, according  to  the  proportion  of  fenforial 
power  diftributed  to  different  people:  hence  the  ex- 
ertion of  which  one  perfon  may  be  capable  will,  in 
another,  bring  on  a  ftate  of  ftupidity* 

The  exiftence  of  this  indireSl  debility  is  likewife 
proved  from  the  analogy  of  the  irregular  ajfociations 
ef  ideas,  with  the  fpaftic  contractions  of  the  other 

mufcles, 


(     %f    ) 

mufcles,  as  well  as  from  the  identity  of  the  caufe5 
viz.  exceilive  application  of  iiimulants. 

Thefe  irregular  motions  of  the  organs  of  fenfe 
may  be  induced  by  any  great  menial  ftimulus,  ap- 
plied in  this  debilitated  (late :  hence  falfe  fenfations, 
in  the  reality  of  which  the  madman  confides ;  and 
from  thefe  proceed  all  thofe  eccentricities  which  cha- 
racterife  him. 

The  phenomena  of  a  cafe  of  oneirodynia  a£livay 
under  my  obfervation,  feem  to  corroborate  this 
opinion.  This  affection  almoft  always  occurs  during 
the  firft  hours  of  fleep,  when  an  indirect  debility  of 
the  organs  of  fenfe,  as  well  as  of  the  whole  body 5, 
muft  be  the  effect  of  the  various  exciting  powers  of 
the  preceding  day :  in  this  cafe  no  alteration  is  made 
by  fatigue  or  reft  of  the  body,  or  by  repletion  or 
depletion  of  the  ftomach ;  but  great  exercife  of  the 
mind  has  a  fenfible  effecl:  in  aggravating  the  parox- 
yfms.-— The  phenomena  of  dreams  likewife  tend  to 
prove  the  exiftence  of  this  ftate ;  for  it  is  well  knovvns 
that  thofe  which  occur  towards  morning  are  much 
more  regular  than  others,  becaufe  the  excitability 
has  been  renovated  by  the  night's  fleep. 

C  From 


(     i8     ) 

From  hence  we  may  learn  why  the  want  of  fleep 
is  fo  inftrumental  in  producing  mania,  fince  there  is 
not  only  an  obftacle  to  the  accumulation  of  excita- 
bility, but  a  frill  greater  wafte  of  it  from  the  objects 
which  engage  the  attention. 

People  of  a  verfatile  and  trifling  difpofition,  and 
whofe  employments  are  diverfified  with  a  pleafing 
variety,  feldom  become  the  victims  of  this  difeafe  J 
from  this  arifes  the  proverb,  "  Fools  never  go  mad.'* 
But  thofe  who  are  flimulated  by  an  ardent  defire  of 
fame,  or  of  riches,  or  from  a  miftakenfenfe  of  duty, 
to  exert  their  utmoft  power,  and  confine  their  atten- 
tion too  long  to  one  fubjed,  often  incur  this  ftate  of 
the  fenfes :  hence  the  chimeras  of  fancy  are  miftaken 
for  realities,  and  propagated  under  the  names  of 
virions,  apparitions,  &c.  Sometimes  the  fame  ex- 
traordinary effort  induces  a  melancholy  dilpofition ; 
and,  as  the  patients  exprefs  it,  they  "  find  themfelves 
unable  to  think."  A  refpectable  clergyman,  in 
England,  was  an  inftance  of  this.  After  confiderabie 
application  to  a  literary  work,  he  became  gloomy  and 
defpondingi  and  in  this  ftate  he  would  declare  that 
God  had  deprived  him  of  his  rational  foul,  and  re- 
duced him  to  the  condition  of  a  vegetable. — Sir 
Isaac  Newton  fell  into  a  melancholy  which  de- 
prived 


(     i9     ) 

prived  him  of  all  thought,  but  was  foon  cured  by 
converting  with  his  friends. 

Since  hope  and  joy  are  mental  ftimulants,  the  ab- 
straction of  them  muft  conftitute  an  afthenia ;  hence 
any  train  of  thought  accompanied  with  defpair  and 
gloomy  apprehenfions,  is  more  efpecially  hurtful. 
Such  are  the  caufes  of  nojialgia^  a  difeafe  more  or 
lefs  felt  by  all  who  are  abfent  from  their  native 
country,  and  confcious  of  the  impoflibility  of  revi- 
sing it.*  I  have  been  informed  that  the  negro 
flaves  in  the  Weft-Indies  are  no  lefs  fubject  to  this 
malady  than  the  Swifs  foldiers.  They  become  dif- 
pirited,  pine  away,  and  finally  lay  violent  hands  on 
themfelves,  unlefs  means  are  ufed  to  interrupt  their 
gloomy  reflections.  The  method  of  cure  confifts  in 
good  treatment,  plenty  of  nourishing  diet,  and  allow- 
ing them  the  pleafure  of  each  other's  company. 

Such  effects  follow  the  indulgence  of  fecret  forrow, 
which  not  being  alleviated  by  communication,  gra- 
dually undermines  the  powers  of  body  and  mind ; 
hence  difappointed  lovers  are  defcribed  as  pale,  de- 
jected, 

*  The  traveller  Bruce,  when  in  Abyfiinia,  far  diftant 
from  every  civilized  face,  defcribes  the  dreadful  defpondency 
which  feized  him  while  indulging  fuch  reflections. 


(       20       ) 

jected,  abfent  in  mind,  and  fond  of  folitude,  or  thofe 
fcenes  which  infpire  a  pkafing  melancholy. — A  re- 
markable inftance  of  diretl  mental  debility,  from  the 
abftraction  of  hope,  is  related  by  Zimmerman.  A 
young  man,  on  meeting  with  a  moft  difcouraging 
repulfe  from  the  object  of  his  affections,  remained 
motionlefs  in  his  chair  for  half  a  day :  from  this  ftate 
he  was  recalled  by  the  agreeable  intelligence  that  his 
fair  one  had  relented. 

Terror  is  fometimes  productive  of  a  flmilar  ftate. 
The  operation  of  a  fright  feems  to  be  the  following : 
a  fudden  abftraction  of  the  ftimulants  hope  and  joy, 
and  a  violent  exertion,  frequently  terminating  in  the 
greateft  debility. 

But  gloomy  reflections  are  not  the  only  remote 
caufes  of  mania.  Exceffive  indulgence  of  joy  often 
produces  the  fame  effect :  it  has  been  known  even  to 
occasion,  by  its  too  great  ftimulus,  a  total  extinction 
of  the  living  principle.  At  the  time  of  the  South- 
Sea  bubble,  Doctor  Hales,  who  had  the  care  of  a 
lunatic  hofpital,  found  that  the  greateft  number  of 
his  patients  were  thofe  who  had  fuddenly  acquired 
fortunes. 

Pride, 


(       21       ) 

Pride,  or  a  too  exalted  opinion  of  one's  own  merit, 
inafmuch  as  it  fubje&s  us  to  more  frequent  difap- 
pointments,  may  be  confidered  as  a  remote  caufe. 
In  madmen,  a  proud  fpirit  is  a  remarkable  cha~ 
racteriftic. 

The  influence  of  government,  in  predifpofing  to 
this  difeafe,  is  a  fubject  worthy  of  confideration, 
were  I  capable  of  properly  tracing  it.  The  referved 
demeanour  and  taciturnity  of  the  Spaniards  and 
Portuguefe  have  been  attributed  entirely  to  their 
apprehenfions  of  the  power  of  the  Inquifition,  which 
formerly  reigned  with  unlimited  fway  in  thofe  coun- 
tries. In  defpotic  governments  raving  madnefs  is 
lefs  frequent,  becaufe  flavery  tends  to  deprefs  the 
mind,  and  prevent  thofe  exertions  which  mark  this 
ftage  of  the  diforder.  Such  eccentricities  refult 
from  a  {enk  of  freedom ;  while  a  gloomy  melan- 
choly is  the  product  of  defpotifm,  except  the  atten- 
tion be  diverted,  and  a  fuperficial  gaiety  induced, 
by  public  fhews  and  entertainments,  or  a  fplendid 
appearance  of  grandeur,  the  common  attendants  of 
fuch  governments. 

Thefe  effects,  however,  may  be  varioufly  modi- 
fied by  the  gloom  or  pleafantnefs  of  the  feafon  and 

fituation. 


(       22       ) 

lituation.  Hence,  in  dull,  foggy  weather,  when 
people,  from  confinement  to  the  houfe,  are  deprived 
of  their  ufual  variety  of  objects,  as  well  as  of  the 
ftimulus  of  light,  low  fpirits  or  fpleen  is  a  common 
occurrence. 


PREVENTION  AND  CURE, 

A  CONSIDERATION  of  the  caufes  enume- 
rated may  ferve  to  direct:  us  in  the  prevention  and 
cure  of  mania. 

The  chief  indications  of  cure  are  the  following : 


During  the  intervals  or  /lighter  degrees  of  the 
affection, 


To  avoid  intenfe  application  of  mind  to  any  fuhjecJ^ 
inordinate  indulgence  of  the  appetites  and  paj/ions, 
and  idlenefs. 

During 


(     23     ) 
During  the  paroxyfms, 

I.  To  remove  the  morbid  fiat  e  of  the  fenfes,  by  ap- 
plying gentle  fiimuli. 

II.  To  refirain  immoderate  exertions. 

Of  the  various  ftimuli  by  which  life  is  fupported 
and  its  functions  performed,  fome  acl:  incefTantly : 
thus  the  heart  and  vefTels,  the  lungs,  and  inteftinal 
canal  obey  their  refpeclive  ftimulants  without  lafli- 
tude  or  debility.  Other  exciting  powers,  by  their 
conftant  application,  have  a  tendency  to  exhauft  the 
excitability ;  and  hence  arifes  the  neceflity  for  a  va- 
riation of  ftimulus,  as  well  as  for  intervals  of  reft, 
that  the  excitability  may  be  recruited.  This  will  ap- 
ply as  well  to  the  mental  ftimuli  as  the  corporeal. 

The  importance  of  variety  in  our  intellectual 
purfuits  muft  be  obvious  to  all  who  have  experienced 
the  undefcribable  and  uneafy  feeling  which  follows 
an  intenfe  or  too  long  continued  application  to  any 
one  fubject.  If  a  perfon  makes  a  violent  exertion 
to  recoiled  any  thing  in  hafte,  he  is  frequently 
baffled;  nor  can  the  idea  be  recalled  till  the  mind 
is  diverted  with  fomething  elfe.     Hence,  in  a  dif- 

eafe 


(       24       ) 

eafe  of  indireEl  mental  debility ',  the  moil  judicious 
practice  muft  be  the  application  of  objects  which 
excite  trains  of  ideas  not  only  different  from  the 
caufe  of  the  difeafe,  but  continually  fhifting  in .  a 
pleating  variety,  and  fufRcient  to  exercife  the  atten- 
tion gently.  In  thofe,  likewife,  who  inherit,  from 
their  parents,  a  predifpofition  to  mania,  the  fame 
treatment  will  be  neceflary  as  a  preventive.  This 
is  conducted  upon  the  principle,  that  when  one 
ftimulus,  by  repeated  application,  renders  the  fyftem 
infenfible  to  its  action,  there  is  ftill  excitability 
enough  left  for  the  operation  of  another.  During 
the  raving  flights  of  a  maniac,  who  was  proclaiming 
himfelf  to  be  the  MeJJiah,  I  have,  by  a  piece  of 
news,  withdrawn  his  attention,  and  obtained  a  ra- 
tional anfwer. 

Such  remedies  are  beft  furnifhed  by  travelling, 
efpecially  with  an  agreeable  companion.  We  have 
the  testimony  of  Doctor  Cullen,  that  in  feveral  ca- 
fes of  complete  mania  a  cure  was  effected  in  the 
courfe  of  a  journey.  On  this  depends  the  benefit 
of  vifiting  certain  mineral  waters,  where  the  change 
of  objects  and  lively  company  contribute  to  divert 
the  mind. 

Gaming 


(25       ) 

Gaming  is  but  a  fallacious  refource,  fince  the  anxi- 
ety and  difappointments  attending  it,  as  well  as  the 
fedentary  life  which  it  requires,  infinitely  overbalance 
the  diverfion  procured:  it  is  like  the  advice  given 
by  an  eminent  phyfician  in  Europe  to  a  hypochon- 
driac who  was  inceflantly  teazing  him  with  his 
complaints :  "  My  friend,"  fays  he,  "  your  bodily 
health  is  good— your  mind  Wants  agitation — I  advife 
you  to  take  your  piftols  and  rob  the  next  man  you 
meet,  and  then  fly  the  kingdom  for  your  life." 

It  is  no  lefs  necefTary  to  avoid  gloomy  company, 
and  all  thofe  objects  which  are  connected  with  former 
fufferings  or  fcenes  of  difgufr,  and  horror.  I  knew 
a  gentleman  who  was  always  affected  with  the  moft 
diftrefling  fenfations  at  the  fight  of  a  houfe  in  which 
he  had  formerly  lingered  under  a  tedious  nervous 
complaint.* 

Thofe  books  which  bewilder  the  reader  in  a  maze 
of  fanatical  abfurdities,  are  efpecially  hurtful  to 
people  who  have  previously  fufFered  under  miftaken 

D  ideas 


*  A  curious  Inftance  of  fympathy  has  occurred  to  me: — 
A  perfon  who  was  formerly  fubject  to  epilepfy  is  always 
feized  with  an  invincible  propenfity  to  laugh  whenever  he  fees 
one  labouring  under  a  fit  of  this  kind., 


(■       26       ) 

ideas  of  the  Almighty,  and  fears  of  his  vengeaftce. 
I  have  lately  {Q&n  an  inftance  of  mania,  where  Swe-' 
denbourg's  and  Richard  Brothers's  reveries 
might  be  fet  down  as  the  occasional  caufes,  in  a 
young  man  who,  on  any  other  topic,  was  perfectly 
rational  j  but  from  the  ftimulus  of  this  train  of  ideas, 
and  the  fruitlefs  attempts  to  comprehend  the  fubject, 
he  was  plunged  into  this  condition. 

The  judicious  adminiftration  of  hope  and  joy  de- 
mands particular  notice :  for  the  operation  of  thefe 
may  be  compared  to  the  circulation  of  the  blood. 
Arreffc  this,  and  the  functions  of  the  animal  ceafe  j 
abftract  the  former,  and  defpair  enfues. — If  the 
imagination  of  the  patient  can  be  averted  from  the 
dread,  of  future  evil,  and  foothed  with  cheering 
hopes,  considerable  progrefs  is  made  towards  ob- 
taining a  cure.  But  of  all  preventives  or  remedies, 
the  moft  effectual  is  a  well-grounded  hope  of  eternal 
happinefs.  Under  the  influence  of  this,  Reafon 
holds  her  fway,  and  diffufes  peace  through  the  foul. 
How  mlftaken,  then,  are  tfrofe  who  annex  the  ideas 
of  fuperftition  and  enthufiafm  to  the  name  of  religion, 
and  who  form  their  opinions  of  its  effects  from  the 
inftances  of  weak,  ignorant  minds  miftaking  their 
bodily  ailments  for  fupernatural  affections ! 

It 


(    27   ; 

•  It  may  feem  rather  extraordinary,  that  the  abjlraci 
lion  of  hope?  or,  in  other  words,  infpiring  the  maniac 
with  fear,  ftiould  be  indicated.  Yet  this  muft  be 
understood  to  refer  only  to  a  fear  of  objects  different: 
from  thofe  which  gave  rile  to  the  difeafe.  For  this 
purpofe  it  becomes  fometimes  neceflary  to  ufe 
rejlraint,  and  to  affert  an  abfolute  authority  over  the 
patient.  This,  however,  mould  be  avoided  as  long 
as  poffible  j  for  it  is  of  no  fmall  confcquence  to  treat 
them  as  rational  beings,  and  conceal  from  them  our 
knowledge  of  their  real  ftate ;  left  the  recollection  of 
their 7?^ 'ait  jackets,  and  chains  and  cells,  fhould  induce 
a  depreflion  of  fpirits  feldom  furmounted.  For 
this  reafon  it  may  fometimes  be  necefTary  to  fall  in 
with  their  opinions,  and,  by  leading  them  to  con- 
clusions of  which  they  were  not  aware,  divert  them 
from  their  rafh  defigns.  Hence  the  moft  proper 
reftraint,  where  convenient,  is  that  of  parental  au,- 
thority,  without  expofure  to  ftrangers* 

Shame  has  a  coniiderable  effect  on  madmen,  for 
few  of  them  will  indulge  in  public  thofe  irregularities 
which  mark  their  conduct  among  their  relatives  and 
intimate  acquaintances.  Plutarch  tells  us,  that 
feveral  virgins  of  Miletus,  from  a  kind  of  endemic 
madnefs,  having  laid  violent  hands  on  themfelves, 

the 


(      28     ) 

the  example  operated  like  contagion,  and  filicides 
became  very  frequent  among  the  women;  till  an 
edict  was  publifhed,  threatening  to  expofe  to  public 
view  the  naked  bodies  of  all  who  ihould  be  guilty 
of  the  like  act.  So  powerful  was  the  fenfe  of  fhame 
in  people  regardlefs  of  life  itfelf,  that,  by  this  ftra- 
tagem,  an  effectual  check  was  put  to  the  practice. 

Induftrious  employment  is  equally  necefiary  to  pre- 
ferve  the  health  of  both  mind  and  body.  The 
happy  ferenity  infpired  by  the  fenfe  of  time  well 
fpent,  might  be  contrafted  with  the  liftleflhefs  and 
difcontent  attendant  on  a  life  of  indolent  fenfuality. 
Among  thofe  of  the  latter  clafs  are  we  to  look  for 
the  mod:  frequent  inftances  of  madnefs ;  but  very 
few  among  people  who  muft  labour  for  their  daily 
bread.— Doctor  Iberti,  in  an  account  of  a  lunatic 
hofpital  at  Saragojfa,  fays,  "  The  cure  is  generally 
attempted  by  cold  bathing  and  refrigerant  medicines, 
but  the  treatment  feldom  anfwers.  Conftant  expe- 
rience has  fhewn,  that  fome  employment  which 
exercifes  the  patient's  limbs  is  the  moft  efficacious 
method  of  cure.  Moft  of  the  lunatics  who  are 
employed  in  the  mops  and  offices  of  the  houfe, 
recover.  Their  occupations  are  cleaning  the  houfe, 
carrying  wood  and  water*  harveft  work,  &c.  Luna- 
tics 


(   n   ) 

tics  of  diftinction,  who  are0  not  employed  in  any 
fervile  occupation,  nor  in  labour  of  any  fort,  feldom 
recover." 

Mujic  is  a  ftimulus  which  has  been  faid  to  excite 
almoft  any  paffion  at  pleafure.  Its  goods  effects,, 
in  calming  inordinate  emotions,  are  often  witnefled, 
efpecially  where  fuch  pieces  of  mufic  can  be  felected 
as  are  aflbciated  With  mirthful  occafions„  The 
Scriptures  inform  us,  that  mufic  was  the  remedy 
employed  by  David  to  foften  the  ferocious  mad- 
nefs  of  Saul 

Plunging  the  patient  unexpectedly  into  cold  water 
has  been  recommended  as  highly  beneficial.  The 
propriety  of  this  practice  I  very  much  doubt,  and 
ihould  be  apprehenfive  that  the  fudden  fhock  would 
be  detrimental,  and  perhaps  produce  fatuity. — Some 
have  directed  the  patient  to  be  kept  from  two  to  fix 
hours  in  fpring  water,  and  even  in  baths  ftill  colder; 
but  this  may  be  objected  to  as  equally  injudicious. 
Frequent  warm  bathing  promifes  much  greater  ad- 
vantages, both  by  applying  a  comfortable  degree 
of  heat,  and  promoting  perfpiration,  which  is  com- 
monly deficient  in  this  ftate  of  the  fyftem, 

Opium;, 


(     30     ) 

Opium,  mufk,  camphor,  and  other  powerful  fti- 
mulants  have  been  exhibited,  but  with  little  sood 
effect  as  far  as  I  can  understand. 

The  refrigerant  plan  of  cure,  recommended  by 
ibme,  belongs  more  properly  to  phrenitis.  To  this 
may  be  referred  bleeding,  purging,  vomiting,  exhi- 
bition of  vinegar,  and  other  remedies  which  act  gene- 
rally •,  as  well  as  thofe  intended  to  obviate  a  preter- 
natural flow  of  blood  to  the  head,  fuch  as  the  ap- 
plication of  the  clay-cap,  ice,  and  ftreams  of  cold 
water;  and  the  prefTure  of  the  carotid  arteries.—^ 
Draftic  purgatives  are  feldom  attended  with  the 
good  effects  attributed  to  them  by  the  ancients :  it 
is,  however,  very  neceffary  to  prevent  coftivenefs, 
by  the  exhibition  of  gentle  laxatives, 

Bliftering  the  head  is  rather  equivocal :  in  phrenitis 
it  may  be  highly  proper ;  but  in  a  cafe  of  chronic 
mania,  in  which  I  have  (etn  a  powerful  epifpaftic 
applied,  no  advantage  was  apparently  derived  from 
it.  Shaving  the  head,  or  thinning  the  hair,  is, 
however,  always  advifeable. 

Leprofy,  and  fome  other  eruptive  difeafes  have 
been    known    to   remove   mania.      How  this  is 

effected. 


(  *  >     / 

effected,  I  am  unable  to  explain,  but  on  the  fuppo- 
iition  that  the  new  action  of  the  veflels  attending 
them  may  produce  a  renovation  and  equable  difFu- 
fion  of  nervous  power.  Doctor  Mutzell,  of 
Berlin,  took  the  hint  from  nature,  and  thought  of 
inoculating  with  the  matter  of  itch  in  this  difeafe. 
The  cafe  of  a  perfon  on  whom  he  made  the  experi- 
ment is  (6  interesting,  that  I  mall  here  infert  it. 

"  The  patient  was  a  man  of  twenty-eight  years 
of  age,  of  a  melancholy  temperament,  and  by  trade 
a  fhoemaker.  Some  family  misfortunes  were  confi- 
dered  as  the  occafional  caufes  of  his  complaints.  He 
became  melancholy,  averfe  to  his  bufinefs,  and  after 
fome  time  had  a  wildnefs  in  his  looks,  and  either 
gave  indirect  anfwers,  or  kept  an  obftinate  filence. 
Many  remedies  were  tried  to  no  purpofe.  He  eve- 
ry day  grew  worfe  and  more  emaciated,  and  was  at 
length  placed  under  the  care  of  Doctor  Mutzell, 
in  the  royal  hofpital  at  Berlin.  He  was  at  this  time 
inattentive  to  every  thing  about  him ;  he  fat  in  bed 
with  his  eyes  fixed,  and  was  fo  great  a  ftranger  to 
hunger  and  thirft,  that  three  or  four  days  continued 
abftinence  did  not  excite  him  to  feek  for  food.  His 
pulfe  was  flow  and  weak.  Neither  external  nor 
internal  ftimuli  feemed  to  have  much  fenfible  effect 
on  hjm.  Whipping  with  nettles  hardly  excited  any 
fenfe  of  pain ;  and  twenty  grains  of  emetic  tartar 

produced 


(     32     ) 

produced  only  one  fit  of  vomiting.  Neither  blif- 
tcrs,  nor  plunging  him  in  cold  water,  nor  a  ftream 
of  cold  water,  nor  plates  of  ice  applied  to  his  head, 
%vere  able  to  occafion  more  than  a  momentary  uneafl- 
nefs.  In  this  ftate  he  continued  two  years,  and  it  was 
then  determined  to  inoculate  the  itch.  For  this  pur- 
pofe,  deep  incifions  were  made  in  the  arms  and  legs, 
and  the  wounds  were  filled  with  itchy  matter.  He 
did  not  feem  to  mind  the  operation ;  but  on  the  fe- 
cond  day  the  pulfe  was  ftronger,  and  on  the  fourth 
was  fo  much  increafed,  that  Doctor  Mcjtzell 
doubted  whether  he  had  ever  felt  a  quicker  pulfe. 
This  degree  of  fever  continued  during  the  fifth  and 
fixth  days,  accompanied  by  great  anxiety  and  difficult 
refpiration.  On  the  two  following  days  the  fever 
abated,  the  fkin  became  moift,  and  a  number  of  fmali 
red  puftules  were  thrown  out  upon  the  furface.  On 
the  ninth  his  fpeech  and  reafon  returned  to  him.  He 
did  not  feem  to  know  any  thing  of  what  had  pafled 
during  the  time  of  his  being  in  the  hofpital.  In 
three  weeks  the  puftules  were  dried  away,  and  he  was 
in  perfect  health." 

With  refpect  to  the  diet  of  maniacs,  it  may  be 
necerTary  to  mention,  that  it  mould  not  be  very  fti- 
mulant,  but  fuch  as  is  nourifhing  and  of  eafy  digef- 
tion :  the  regulation  of  this,  however,  will  depend 
on  the  degree  of  exercife  ufed,  and  the  patient's 
former  habits  of  life. 

F  IN  I  S. 


COLUMBIA  UNIVERSITY  LIBRARY 

This  book  is  due  on  the  date  indicated  below,  or  at  the 
expiration  of  a  definite  period  after  the  date  of  borrowing 
as  provided  by  the  rules  of  the  Library  or  by  special  ar- 
rangement with  the  Librarian  in  charge. 


DATE  BORROWED 


DATE  DUE 


DATE  BORROWED 


DATE  DUE 


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